Volume 24, Issue 4, 2016
Review
The 2009 influenza A virus - subtype H1N1 pandemic, a glance from Greece
Tsoucalas Gregory,
Sgantzos Markos
The 2009 influenza A - subtype H1N1 pandemic tested the public health care systems all around the globe, infecting millions and leading to thousands of deaths. Greece became the epidemic centre of the 2009 flu pandemic due to the low compliance of the general population towards the vaccination programme, the resistance acquired against antiviral drugs and the economic scenario at the time. Our study, after a thorough research in the "Medline/PubMed, Scopus, Google Scholars" medical databases, accompanied by a wide range of literature from Greece, sought to have a closer look at the pandemic from a Greek perspective. Finally, we used as key words the terms: "2009, flu, influenza A - H1N1 virus, vaccine, pandemic, Greece".
Visceral leishmaniasis in immunocompromised: diagnostic and therapeutic approach and evaluation of the recently released IDSA guidelines
Pagliano Pasquale,
Ascione Tiziana,
Di Flumeri Giusy,
Boccia Giovanni,
De Caro Francesco
Visceral Leishmaniasis (VL) is a chronic infectious disease endemic in tropical and sub-tropical areas including the Mediterranean basin, caused by a group of protozoan parasites of the genus Leishmania and transmitted by phlebotomine sandflies. Typically, VL is classified as a zoonotic infection when Leishmania infantum is the causative agent and as an anthroponotic one when L. donovani is the causative agent. Immunocompromised patients, in particular HIV positive, are considered at risk of VL. They may present atypical signs and poor response to the treatment due to a compromission of T-helper and regulatory cells activity. Also pregnancy can be considered a condition predisposing to Leishmania reactivation and to the changes in immune response, due to a switch toward a Th2 response reported in this condition of the life. Laboratory diagnosis is based on microscopy for parasites detection on bone-marrow or spleen aspirates. Value of serology remains high in term of sensibility, but a positive test has to be confirmed by microscopy or molecular tests. Hypergammaglobulinemia and pancytopenia are the main alteration identified by blood examination. Treatment is based on use of liposomal amphotericin B (L-AmB) whose administration is associated to lower incidence of side effects, in respect to antimonials and other formulations of AmB. Use of Miltefosine needs further investigation when L. infantum is the causative agent. Relapses to treatment are observed in coinfected HIV patients. They can benefit of a second cycle, but cumulative efficacy of the treatment can be low.
Original article
Genotypic analysis of HCV 1a by sequencing of the NS3 proteasic region in simeprevir therapy candidates
Liberti Alfonso,
Raddi Adriana,
Cuomo Nunzia
Each phase of the HCV replication cycle can represent a therapy target. In fact, SIMEPREVIR (SMV) acts as NS3/4A protease inhibitor (PI); its efficacy is, however, reduced in HCV1a patients characterized by NS3Q80K polymorphism. The aim of this work was to design a genotypic analysis of NS3 protease in order to characterize viral quasispecies in HCV 1a patients before starting the SMV therapy. In all, 38 peripheral blood-EDTA samples were collected from patients infected with HCV 1a (RNA > 10,000 cp/ml). The samples were sequenced in a region of 543 nucleotides, codifying for 181 amino acids of the NS3 protease with ABI PRISM 3130xl Genetic Analyzer (Applied Biosystems). Of the 38 samples, two showed the Q80K mutation associated with resistance to SMV. In 16 samples mutations associated with a possible resistance to protease inhibitor, TELAPREVIR, were observed. Only one sample showed the T54S mutation, which is responsible for resistance to BOCEPREVIR, a protease inhibitor too. The data reported in this paper show a 5% prevalence of the Q80K mutation in HCV 1a patients. So far, some differences in the percentage of the Q80K mutations were observed within the European population, when compared with its US counterpart. The prevalence study described herein, albeit observed on a low number of samples, could challenge the recommendations reported in the technical data sheet of SMV.
Tenofovir disoproxil fumarate monotherapy maintains HBV suppression achieved by a “de novo” combination of lamivudine-adefovir: a pilot study
Ruggiero Giuseppe,
Marrone Aldo,
Rainone Ilaria,
Boemio Adriana,
Adinolfi Luigi Elio,
Pasquale Giuseppe,
Rinaldi Luca,
Guerrera Barbara,
Andreana Lorenzo,
Zampino Rosa
Chronic hepatitis B (CHB) treatment aims at long-term suppression of HBV replication and improvement in clinical outcomes. We describe the data of a pilot, non-profit study in which patients with CHB were treated with de novo combination lamivudine-adefovir (LAM-ADV) for at least four years with a view to HBV suppression and resistance prevention, and shifted to tenofovir (TDF) when new antiviral agents were available.
Fifty-one HBeAg negative patients were enrolled. Histology was available for 39 patients and data of liver stiffness (LS) for 24 patients at baseline. Serum quantification of HBsAg and HBVDNA was obtained regularly during the follow-up. In 10 and 7 patients, a paired histology and LS were available at the end of LAM-ADV treatment, respectively. The de novo LAM-ADV combination was able to obtain HBVDNA suppression and ALT normalization in one year in most of the patients and in the second year in the remaining. Histology improved in patients with paired biopsy, but tissue HBsAg was present in all but one patient after 48 months of therapy. TDF maintained biochemical and virological response throughout the follow-up. Renal impairment during LAM-ADV therapy improved on shifting to TDF; only in 4 cases was a second shift to entecavir needed. TDF was safe and effective in maintaining HBV DNA suppression achieved by a long-term course of LAM-ADV de novo combination for the treatment of HBeAg-negative CHB.
Comparison of the Elecsys HBsAg II Assay and the Architect Assay for Quantification of hepatitis B surface antigen in patients with chronic hepatitis B
Karagoz Ergenekon,
Selek Mehmet Burak,
Tanoglu Alpaslan,
Hatipoglu Mustafa,
Ulçay Asım,
Turhan Vedat
Quantitative hepatitis B surface antigen (HBsAg) is a valuable tool in hepatitis B virus (HBV) disease diagnosis and management for evaluating the effectiveness of antiviral therapy. The aim of the current research was to compare the performances of the Elecsys HBsAg II and Abbott Architect HBsAg assays in chronic hepatitis B (CHB) patients. Between May 2014 and December 2014, 72 CHBs were tested using Abbott Architect HBsAg QT and Roche Elecsys HBsAg II assay. After transformation to log (10) IU/mL, the results of the two assays were compared using the interclass correlation test, the Pearson correlation test and Bland–Altman analyses. We also analyzed all the parameters in on-treatment patients and naive patients with Pearson correlation test. There was a significant overall correlation between the Elecsys and Architect assays. We also analyzed all the parameters in naive and on-treatment patients. There was a significantly good correlation between the two assays in untreated patients and on-treatment patients. In this study, there was a significant correlation between the results of the Elecsys HBsAg II and Abbott Architect HBsAg assays in the overall and naive/on-treatment CHB patients. Additionally, we found that mean HBsAg levels resulting from the Architect assay were higher than those obtained by Elecsys assay
Does antimicrobial usage before meningitis lead to a higher risk of adult postsurgical Acinetobacter baumannii meningitis than that of Enterobacteriaceae meningitis?
Demiraslan Hayati,
Ulutabanca Halil,
Ercal Baris Derya,
Metan Gokhan,
Alp Emine
Acinetobacter baumannii and Enterobacteriaceae are two pathogens responsible for postneurosurgical meningitis. The aim of this retrospective study was to evaluate the factors that influenced the outcomes in patients with postneurosurgical meningitis caused by A. baumannii and Enterobacteriaceae. Patients with post-surgical meningitis were identified from infection control committee charts between 2007 and 2015. Subjects over 16 years old who had positive cerebral spinal fluid cultures for A. baumannii or Enterobacteriaceae were enrolled in the study. Clinical and laboratory data for 30 patients with A. baumannii meningitis were compared with those of 12 patients with Enterobacteriaceae meningitis. The mean age of patients was 51.9 years and 57.1% were male. Eleven patients had comorbidities, the most common being diabetes mellitus. Most patients were due to intracranial haemorrhage (78.6%). The rate of the patients who received an appropriate antimicrobial therapy was 35.7%, and the crude mortality rate was 64.3%. In univariate analysis, previous antibiotic use, an infection before meningitis and mechanical ventilation had an increased risk of A. baumannii meningitis. Moreover, intrathecal antimicrobial use, inappropriate empirical antimicrobial use, antimicrobial resistance and alanine aminotransferase elevation were significantly higher in patients with A. baumannii meningitis than in those with Enterobacteriaceae meningitis. Antimicrobial use before meningitis (8.84 times) and mechanical ventilation (7.28 times) resulted in an increased risk of A. baumannii meningitis. None of the results affected 30-day mortality. Avoidance of unnecessarily prolonged antimicrobial usage may help to prevent a selection of A. baumannii.
Are municipal solid waste collectors at increased risk of Hepatitis A Virus infection? A Greek cross-sectional study
Rachiotis George,
Tsovili Eva,
Papagiannis Dimitrios,
Markaki Adelais,
Hadjichristodoulou Christos
Municipal solid waste collectors are reportedly at risk for Hepatitis A virus infection (HAV) as an occupational hazard. We aimed to investigate the prevalence and possible risk factors of HAV infection among solid waste collectors in a municipality of the broader region of Attica, Greece. A cross-sectional sero-prevalence study was conducted. Fifty (n=50) waste collectors participated in the study (response rate: 95%). The group of municipal waste collectors was compared to a convenient sample of workers not exposed to solid waste (n=83). Municipal solid waste collectors recorded a higher- but not statistically significant- prevalence of anti-HAV(+) in comparison to subjects without occupational exposure to waste (40% vs 34% respectively p=0,4). No significant associations were found between inappropriate work practices and anti- HAV (+). Education was the only factor independently associated with the risk of HAV infection. This study did not corroborate previous reports of an increased prevalence of Hepatitis A Virus infection among municipal solid waste collectors.
Performance of real-time PCR Xpert ®MTB/RIF in diagnosing extrapulmonary tuberculosis
Mazzola Ester,
Arosio Marco,
Nava Alice,
Fanti Diana,
Gesu Giovanni,
Farina Claudio
The real time PCR Xpert ®MTB/RIF is fundamental for rapid diagnosis in paucibacillary respiratory samples and for the detection of multidrug-resistant TB cases. This paper aimed to determine its performance on different extrapulmonary samples. We determined sensitivity, specificity, positive and negative predictive value on respiratory and non-respiratory samples collected from January 2010 to June 2014. The protocol for the Xpert ®MTB/RIF PCR suggested by Cepheid was strictly followed for all specimens. In 12257 respiratory samples we observed a sensitivity of 87.1% and a specificity of 99.9%. There were 2818 extrapulmonary specimens, of which 250 were followed by a positive culture for Mycobacterium tuberculosis complex, whereas 72 samples were culture-negative: tuberculosis was clinically confirmed in 71 of them and was excluded for one sample. The sensitivity of the test on urine, pus and CSF samples was 88.2%, 95.6% and 100% respectively. In contrast, the sensitivity of gastric aspirates and biopsies was 81.8% and 83.6% respectively, whereas results of total cavitary fluids were significantly worse than expected (53.7% sensitivity). Our experience shows that Xpert MTB/RIF assay is an accurate, sensitive, and specific test for the rapid detection of pulmonary and extra-pulmonary TB with the only exception of cavitary fluids.
Reduced wound infection in colorectal resection by using a wound auto-retractor
Arenal Juan J.,
Martínez Agustín,
Maderuelo María V.,
Tinoco Claudia,
Benito César,
Citores Miguel A.,
Eiros José M.
Surgical site infection (SSI) remains an important problem in colorectal surgery. The aim of this study is to determine whether the use of a wound protection system can be effective in reducing the incidence of wound infection after colorectal resection. Ninety-five consecutive patients underwent colorectal resection, carried out by one single surgeon during a six-year period (2009-2015). A laparotomy auto-retractor was used in all cases (Alexis Wound Retractor; Applied Medical, Rancho Santa Margarita, CA). Forty-two resections (44%) were made by laparoscopy. Anastomoses for laparoscopic right colectomies, section of left colon and insertion of the anvil of CEEA for laparoscopic left colectomies were made extracorporeally. No colon cleansing was used in 67 patients (72%). The median age for those undergoing colectomy was 67 (range 41-90). The median Body Mass Index was 25.04 (range 18- 36.76). Three patients (3%) were operated on an emergency basis because of bowel obstruction or perforation. Fifty-three patients were classified ASA I-II (56%). There were six re-operations, for anastomotic dehiscence, peri-ostomal cellulitis and postoperative bleeding. The median postoperative stay was eight days (range 3-28). Only one patient (1%) developed wound infection. Due to the significantly reduced incidence of postoperative wound infection, this study suggests that the Alexis retractor be considered for routine use.
Extended-Spectrum Beta Lactamase-producing Enterobacteriaceae among the pediatric population: who is at risk and why? Results from a single-centre prospective study
Calitri Carmelina,
Scolfaro Carlo,
Colombo Sara,
De Intinis Gianfranco,
Carraro Francesca,
Garazzino Silvia,
Tovo Pier-Angelo,
A prospective 18-month case-control study was performed in a tertiary Paediatric Centre in Turin (Italy) to analyse the disease burden and identify risk factors for acquisition of Extended Spectrum Beta Lactamase-producing Enterobacteriaceae (ESBL-pE). Children with ESBL-pE isolation were enrolled as cases, with controls matched according to age, type of pathogen isolated and sample of isolation.
Out of 83 children (37 males, mean age 4.7 ± 5.46 years), 45 were identified as infected (54.2%) and 38 as colonised (45.8%) by ESBL-pE. Twenty-nine (64.4%) infectious disease episodes were categorised as community-acquired, 16 (35.6%) as healthcare-associated. Escherichia coli was the most frequently isolated pathogen (52, 62.7%) and the urinary tract the most frequent site involved (26, 57.9%). No deaths occurred, even in bloodstream infection cases. Hospitalisation and exposure to broad-spectrum penicillins and III/IV generation cephalosporins in the 90-day period before bacteria isolation were found to be independent risk factors at multivariate analysis. Immunodepression, prolonged central venous catheter (CVC) and urine catheter stay, and receiving a total parenteral nutrition (TPN) in the previous 30 days were otherwise recognized as potential risk factors at univariated analysis. ESBL-producing Enterobacteriaceae infections are a growing threat even in children. Careful recognition of patients at risk should promote targeted interventions in order to reduce the ESBL burden.
Comparison of quinolone and β-lactam resistance among Escherichia coli strains isolated from urinary tract infections
Tayebi Zahra,
Heidari Hamid,
Kazemian Hossein,
Ghafoori Seyed Mohammad,
Boroumandi Shahram,
Houri Hamidreza
The growing frequency of antibiotic resistances is now a universal problem. Increasing resistance to new generations of β-lactam and quinolone antibiotics in multidrug-resistant Enterobacteriaceae isolates is considered an emergency health issue worldwide. The aim of this study was to evaluate plasmid-mediated quinolone resistance genes in ESBL-producing Escherichia coli isolated from urinary tract infections (UTIs). In our study ESBL-producing isolates were assessed by screening methods. After determination of antimicrobial susceptibility testing, detection of ESBLs and quinolone resistance genes was performed. A total of 97 ESBL-producing E. coli were determined. The blaTEM, blaSHV and blaCTX-M genes were detected in 90 isolates. The blaTEM was the most frequently detected gene (46.4%), followed by blaSHV (31.9%) and blaCTX-M (14.4%). The most prevalent quinolone resistance genes among ESBL-producing isolates was oqxAB which was found in 67 isolates (69.1%). The frequencies of the aac(6’)-Ib-cr, qnr and qepA were 65 (67%), 8 (8.2%) and 6 (6.2%) respectively. Our data indicate that prevalence of plasmid-mediated quinolone resistance genes in ESBL-positive isolates is increasing. The co-dissemination of PMQR and ESBL genes among E. coli isolates can be considered a threat to public health. Therefore, prescription of antibiotics against infectious disease should be managed carefully.
Zinc sulphate for acute bronchiolitis: A double-blind placebo-controlled trial
Mahyar Abolfazl,
Ayazi Parviz,
Ahmadi Negin Khoshbakht,
Pour Nikoo Sara Talebi,
Hamzehloo Samaneh,
Taremiha Alireza,
Yazdi Zohreh,
Esmaeily Shiva
The use of adjunctive therapies to achieve rapid recovery from clinical symptoms of acute bronchiolitis would appear necessary. This study was performed to determine the effect of zinc sulphate on treating acute bronchiolitis. In this study, 100 children affected with acute bronchiolitis were investigated. Fifty patients received oral zinc sulphate and 50 patients placebo. Signs and symptoms of the disease were compared between two groups at the time of admission and then 24, 48, 72, 96 and 120 hours after the beginning of treatment. The trend of recovery of clinical signs and symptoms was more favourable in the case group than in the control group in 24, 48, 72, 96 and 120 hours after beginning of the treatment. The significant differences were observed between the two groups in terms of improvements in coughing and wheezing 48 and 72 hours after the beginning of the treatment (P<0.05). Full recovery was observed in 49 (98%) patients receiving zinc sulphate within 72 hours of the beginning of treatment (P=0.0001). The present study showed that administration of zinc sulphate accelerates improvement from clinical signs and symptoms of acute bronchiolitis. Thus we recommend the use of zinc sulphate for the treatment of acute bronchiolitis.
Case report
Tuberculous pericarditis: a case report
Denk Affan,
Kobat Mehmet Ali,
Balin Safak Ozer,
Kara Sumeyye Selim,
Dogdu Orhan
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Firat University; Department of Cardiology, Faculty of Medicine, Firat University; Department of Infectious Diseases and Clinical Microbiology, Elazig Training and Research Hospital, Elazig, Turkey
Four cases with Kawasaki disease and viral infection: aetiology or association?
Giray Tuba,
Biçer Suat,
Küçük Öznur ,
Çöl Defne,
Yalvaç Zerrin,
Gürol Yeşim,
Yılmaz Gülden,
Saç Ahmet,
Moğol Yiğit
The aetiology of Kawasaki disease has not yet been precisely determined. It has been associated with a variety of bacterial and viral agents. Some viruses including human adenovirus, coronavirus, and parainfluenza virus type 3 have been isolated from patients with Kawasaki disease. Clinical presentation of patients with human coronavirus and adenovirus infections mimics Kawasaki disease. In addition, these viruses may also be detected in Kawasaki disease as a coinfection. In this report, we present four Kawasaki disease patients infected with adenovirus, coronavirus OC43/HKU1 and parainfluenza virus type 3.
Pulmonary and Vertebral Mycobacterium avium Disease in a HIV-negative 71-year-old Man – A Case Report
Stjepanović Mihailo I.,
Pešut Dragica P.,
Lešić Aleksandar R.,
Stević Ruža S.
Nontuberculous mycobacteria (NTM) caused pulmonary disease is on increase worldwide, especially in countries with decreasing time trend of tuberculosis incidence. NTM skeletal affection is rare. Mycobacterium avium related disease, with still unclear clinical and radiologic features, is in current focus of both clinicians and researchers.
An exhausted severely ill 71-year-old man was admitted on emergency due to cough, dyspnea and lumbar back pain to be diagnosed with terminal phase M. avium disease. Three sputum smears were positive for acid fast bacilli and M. avium was identified with hybridization reaction by means of GenoType® MTBC (Hain). Apart from pulmonary disease, compressive fractures of the 12th thoracic and 1-4th lumbar vertebrae were detected. We found age, chronic alcoholism, previous professional exposure, tobacco smoking, chronic obstructive pulmonary disease and previous tuberculosis as risk factors for NTM disease in the HIV-negative patient. Despite combined antibiotic treatment, disease had lethal outcome. This case report might contribute to clinicians’ awareness and improved knowledge on this sort of pathology, and lead to earlier diagnosis with possibly better disease outcome.
The Infections in the History of Medicine
Hospital management in patients with Dengue: what challenges do we face in Latin America?
Torres-Roman Junior Smith,
Díaz-Vélez Cristian,
Bazalar-Palacios Janina,
Helguero-Santin Luis Miguel
Not available
Dental worm disease
Sabbatani Sergio,
Fiorino Sirio
During human evolution, the period in which groups of humans stopped harvesting fruits and seeds growing wild and introduced the cultivation of cereals as well as the domestication of animals represents a very important event. This circumstance had a considerable impact on human pathocenosis, increasing the risk of infectious diseases of animal origin.
The aim of this review was to summarise the archaeological and palaeo-pathological evidence in the literature concerning this topic. Starting from early prehistory (about 1.5 million years ago) up to the historical period, several authors have described the changes in human habits and the consequent changes in food supply, leading to the transition from a protein- to a carbohydrate-rich diet across a broad interval of time. This led to additional problems for human health. The increased accumulation of carbohydrate debris in the odonto-stomatological apparatus, without the appropriate use of hygiene in the oral cavity, increased the risk of infectious disease involving the mouth. Therefore, since the Neolithic period there has been a higher risk of tooth caries, abscesses, deep infection of the teeth roots, reaching also the mandibular and maxillary bone. Several hypotheses have been proposed by the distinct civilizations, which have alternated in the different ages, to explain the cause of these human health problems, including the idea that a “dental worm” could be involved in this process, such as in the Sumerian period. We describe and discuss further modifications of this theory, developed in Egypt, Assyria, Babylon, China, Greece, in Etruscan cities and in Rome in ancient times as well as in the Middle Ages, and the evolution of scientific thought on this topic in the past 300 years. In addition, the results of some palaeo-pathological studies, which were performed on human remains, such as the maxillary bone and teeth, mainly in different geographical areas in Italy, are examined and reported.
